The controversy with community water fluoridation arises from moral, ethical, political and safety concerns with respect to water fluoridation. As far back as 1930, there was a relationship inversely between the levels of fluoride in drinking water and existence of dental caries. Any practice like fluoridation, which uses the public water supply to deliver the medicine violated the medical ethics. The ethical issues associated with the water fluoridation include- balancing risks and benefits, presence of any other interventions with the same outcome, the role of consent. Fluoridation violates the principle of informed consent. On the other hand, in public health practice the principle of beneficence has more weight than the principle of autonomy.
There were two objections because the fluoridation of water has some undesirable side effects such as development of Down syndrome and Cancer in the areas where fluoridated water is supplied. Apart from this, the second objection was allied to it being a compulsory medication. Opponents insist compulsory community water fluoridation violates the ethical principle of autonomy. Objection due to suspicion of more amount of fluoride which leads to cancer is justifiable with the ethical principle of Non-maleficence. However, it is not actually based on scientific aspects. The second objection i.e. compulsory medication is related to the principle “autonomy” this demonstrates the controversy between the principle of autonomy and positive effects of community water fluoridation (beneficence).
However, in Britain (1985), the report of the working committee on fluoridation of water and cancer has no evidence in development of cancer in association with fluoridation of water. And many other groups reached the same conclusion. Harris in his article pointed that, in a society we have to accept the diminution in our autonomy. (Harris). The ethics committee should be elaborated to incorporate community and primary care services, and certainly department of public health. The public health should respect the individual rights of the community and achieve community health. So, many questions arise here e.g. Is mass medication of uncontrolled dose of fluoride in community water supplies wrong? Is fluoridation right if there are fewer risks than benefits?
LITERATURE OVERVIEW: The literature review revealed that the first argument against the community water fluoridation was related to the principle of autonomy. There are many people who are drinking artificial fluoridated water worldwide due to the supply of fluoridated water in many countries. Some countries like china, India and Africa have areas with natural fluoride levels in water. As fluoride causes many health related problems these countries are taking some measures to remove the levels of fluoride content in water.
In 1957, New Zealand Commission of Inquiry put at rest the ethical concerns related to water fluoridation because they found...